Acute Respiratory Distress Syndrome in Pregnant Women. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Rush, Barret; Martinka, Pawel; Kilb, Brett; McDermid, Robert C.; Boyd, John H.; Celi, Leo Anthony
• Is Part Of: Obstetrics and gynecology. Volume 129:Issue 3(2017)
• Publication Date: 2017-03
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000001907
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality. METHODS: We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created. RESULTS: A total of 55, 208, 382 hospitalizations from the 2006–2012 Nationwide Inpatient Samples were analyzed. There were 2, 808 pregnant patients with ARDS who underwent mechanical ventilation included in the cohort. The overall mortality rate for the cohort was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% confidence interval [CI] 33.1–39.8) per 100, 000 live births in 2006 to 59.6 cases (95% CI 57.7–61.4) per 100, 000 live births in 2012. Factors associated with a higher risk of death were prolonged mechanical ventilation (adjusted odds ratio [OR] 1.69, 95% CI 1.25–2.28), renal failure requiring hemodialysis (adjusted OR 3.40, 95% CI 2.11–5.47), liver failure (adjusted OR 1.71, 95% CI 1.09–2.68), amniotic fluid embolism (adjusted OR 2.31, 95% CI 1.16–4.59), influenza infection (OR 2.26, 95% CI 1.28–4.00), septic obstetric emboli (adjusted OR 2.15, 95% CI 1.17–3.96), and puerperal infection (adjusted OR 1.86, 95% CI 1.28–2.70). Factors associated with a lower risk of death were: insurance coverage (adjusted OR 0.56, 95% CI 0.37–0.85), tobacco use (adjusted OR 0.53, 95% CI 0.31–0.90), and pneumonia (adjusted OR 0.70, 95% CI 0.50–0.98). CONCLUSION: In this nationwide study, the overall mortality rate for pregnant patients mechanically ventilated for ARDS was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% CI 33.5–41.8) per 100, 000 live births in 2006 to 59.6 cases (95% CI 54.3–65.3) per 100, 000 live births in 2012. Abstract : Supplemental Digital Content is Available in the Text.The overall mortality rate in pregnant patients with acute respiratory distress syndrome is 9%, with an increase from 36.5 cases per 100, 000 live births in 2006 to 59.6 cases per 100, 000 live births in 2012, observed.